The competitive bidding program fundamentally changed Medicare’s approach to reimbursing DMEPOS suppliers under Medicare Part B. Prior to the program, Medicare paid for these items using a fee schedule generally based on historic supplier changes. Officials believed these fees were excessive and began implementing the new system in 2011 to establish a single Medicare payment for each item through a bidding process between CMS and designated suppliers. The program was originally rolled out in a limited number of metropolitan statistical areas (MSAs) and then expanded in “rounds.”

What Members Need to Know

The competitive bidding program has had a significant impact on HIDA member suppliers of nursing home, home care and extended care products as well as the providers they serve. To date, there has been little independent analysis to evaluate how significantly the program has restricted the types of products available for patients or compromised physician decisions to prescribe specific products that are determined to be most appropriate for the patient’s medical and physical condition.

HIDA’s concern, and that of other organizations, is that restricting access to products determined to be essential for their unique medical conditions could lead to major adverse health events for patients and increased utilization and spending for Medicare. In particular, HIDA has raised concerns about how quickly the Centers for Medicare and Medicaid Services (CMS) is phasing in prices for DMEPOS established in competitively bid areas to those areas that have not been subject to competitive bidding, mostly in rural areas with a higher “cost to serve.”

Product areas covered under the DMEPOS competitive bidding program include:

Outlook

In early February, CMS announced they would temporarily delay the next steps in setting up a consolidated round of DMEPOS competitive bidding in 2019. This decision was made to give the new administration an opportunity to further review the program. The agency removed all information on the 2019 round of bidding that was released January 31 st from its website. Current competitive bidding contracts are set to end December 31, 2018 so the agency will need to set the next round unless CMS extends the current contracts or there is a change to the law.

CMS advises providers to continue to monitor these websites – www.cms.gov and www.dmecompetitivebid.com – for updates. HIDA will continue to monitor and provide updates regarding further implementation of the competitive bidding program under the Trump Administration.